Where do you turn when you’ve hit rock bottom?
It can be hard to know where to turn for substance-abuse treatment in Canada
You’ve hit bottom and want help for your drug addiction. Where do you turn? The answer lies in a patchwork of residential drugrehabilitation centres and non-residential self-help programs, counselling, and treatment services.
Some programs are strictly psychological interventions, while others involve the use of medication. Programs can be motivational or confrontational, one-on-one or as part of a group. What works? “There is no agreement. You’ll get a variety of dogmatic opinions. But basically you’re condemned to have a variety of opinions as to what’s best,” said Bruce Alexander, a professor emeritus of psychology at Simon Fraser University.
Drug-treatment strategies have come under scrutiny in the wake of the death of 31-year-old Canadian actor Cory Monteith, star of the hit TV series Glee, from a heroin and alcohol overdose.
Monteith had reportedly checked himself into a drugrehab facility — it is not known where — in April. His death in a Vancouver hotel last weekend prompted headlines like “When Rehab Doesn’t Work” and “How the Drug Treatment System Failed Cory Monteith.”
Similar questions followed the alcohol-related death two years ago of singer/song writer Amy Winehouse, whose single Rehab included the lyric, “They tried to make me go to rehab, but I said, ‘no, no, no.’ ”
Figuring out the best course of treatment depends on your profile, experts say. Are you an occasional user or an everyday user? For two years or two decades?
Those who are more severely addicted, for instance, might be better suited going to an in-patient treatment facility.
Whether attending an inpatient or outpatient program, approaches vary widely in terms of the counselling clients receive.
One approach, called motivational enhancement therapy, gets the client to reflect on the consequences of their drug use on their health, their relationships, and priorities in life, said Julian Somers, a clinical psychologist and professor at SFU.
Sometimes, delivering the hard facts can be quite impactful, such as telling a client that consuming a certain amount of a drug, at their weight, could be lethal, he said.
Other strategies might focus on addressing the possible roots of someone’s drug use, such as a childhood trauma, and helping them develop other coping skills.
“I don’t believe that traditional rehab using selfhelp methods is
effective. ”
PROFESSOR BANKHOLE JOHNSON
(Monteith’s troubles reportedly began following his parents’ divorce when he was young).
Another approach might be to get the client to focus on scenarios that lead to drug use, and finding ways to avoid those scenarios. If drugs were used in the past as a way to unwind or to celebrate an occasion, for instance, are there alternative activities?
Some programs require complete abstinence from day one of treatment, while others identify ways of reducing harm without necessarily requiring abstinence. This latter approach recognizes that some people are unprepared to stop their drug use and puts more emphasis on minimizing the risks of death, disease or injury.
Tim Stockwell, a professor of psychology at the University of Victoria, said one of the pitfalls of abstinence-centred programs is after a period of abstinence, tolerance levels drop, so if a client relapses and uses the same dosage they had used before treatment, they could overdose.
Drug-based therapies are not fully developed but some have shown promise. Methadone, for instance, has been used to treat heroin addicts. Because it is an opiate substitute, it helps to prevent the onset of withdrawal symptoms, while also blocking the euphoric effects of heroin, according to a Health Canada study examining substance abuse treatment.
In an article in Scientific American after Amy Winehouse’s death, Bankhole Johnson, a professor of neuroscience at the University of Virginia School of Medicine, said while there wasn’t a good drug yet for cocaine addiction, there were drugs to help treat alcohol and opiate addictions.
“I don’t believe that traditional rehab using self-help methods is effective. In fact, the data suggest that they’re not much better than spontaneous rates of recovery,” he was quoted as saying.
“The medicines that work are better than the psychological treatment alone.”
One growing area is pet or animal-assisted therapy, pairing drug-addicted individuals with dogs, cats, even horses, as a way to help them relieve stress and anger and feel compassion.
A high-tech experimental treatment developed out of Duke University uses video software to expose drug-addicted individuals to a virtual world that might simulate a crack den, for example, and then aims to help them con- trol their cravings. Following an intensive phase of treatment, experts agree followup care is critical to success. That means ensuring that individuals have support from professionals, family and friends who can help them stay on track.
“It’s not a one-quick fix,” said Colleen Dell, a professor of sociology and public health, and research chair in substance abuse at the University of Saskatchewan.
Somers said while a lot of treatment programs have been set up to help drugaddicted individuals with severe or complex needs, such as those with mental disorders, who are pregnant or who have HIV/AIDS, there still remains a lack of programs for the majority of people with addictions.
That said, he acknowledged that Canada has been a “pioneer” in certain areas, including providing services to homeless people with addictions and in its treatment of criminal offenders who are drug-dependent.
A report a few years ago by the National Treatment Strategy Working Group in Ottawa identified the harmful use of alcohol and drugs as a $40-billion-a-year problem in Canada and called for greater integration between health and social service providers to help those with substance abuse problems.
“The vast majority of Canadians affected by substance abuse problems do not use specialized addiction services. However, they do access other sectors of the healthcare system — as well as other systems such as social services, housing and education,” the report said.
“Research findings suggest that providing appropriate services and supports across a range of systems not only reduces substance use problems but also improves a wide range of outcomes related to health, social functioning and criminal justice.”